急性NSTEMI患者PCI术后血清FAR、γ-GGT、NT-proBNP水平及对预后的预测价值研究

Levels of serum FAR,γ-GGT and NT-proBNP,and their predictive value for prognosis of patients with NSTEMI after PCI

目的探讨并分析急性非ST段抬高心肌梗死(NSTEMI)患者经皮冠状动脉介入治疗(PCI)术后血清纤维蛋白原/白蛋白值(FAR)、γ-谷氨酰转肽酶(γ-GGT),N端脑钠肽前体(NT-proBNP)水平对预后的预测价值。方法回顾性分析2020年2月至2023年2月邯郸市中心医院收治的实施PCI的急性NSTEMI患者93例,根据术后30 d主要不良心血管事件(MACE)发生情况将其分为MACE组(n=21)及无MACE组(n=72)。比较术前、术后30 d MACE组及无MACE组血清FAR、γ-GGT、NT-proBNP水平,采用单因素和多因素Logistic回归分析对影响急性NSTEMI患者术后30 d MACE发生的危险因素进行分析,采用受试者操作特征(ROC)曲线分析血清FAR、γ-GGT、NT-proBNP水平对急性NSTEMI患者术后MACE发生的预测价值。结果MACE组年龄为(65.37±3.46)岁;Killip分级为Ⅰ级2例,Ⅱ级3例,Ⅲ级5例,Ⅳ级11例;病变支数双支5例,3支16例;术后30 d血清FAR、γ-GGT、NT-proBNP水平分别为(2.87±0.55)%、(53.27±3.06)U/L、(914.35±84.35)ng/mL。无MACE组的年龄为(58.71±2.86)岁;Killip分级为Ⅰ级32例,Ⅱ级27例,Ⅲ级7例,Ⅳ级6例;病变支数为双支53例,3支19例;术后30 d血清FAR、γ-GGT、NT-proBNP水平分别为(2.12±0.51)%、(44.33±3.35)U/L、(656.82±75.63)ng/mL。MACE组和无MACE组的年龄、Killip分级、病变支数及术后30 d血清FAR、γ-GGT、NT-proBNP水平比较,差异均有统计学意义(P<0.05),两组性别、吸烟史、高血压史、高血脂史、糖尿病史及术前1 d血清FAR、γ-GGT、NT-proBNP水平比较差异无统计学意义(P>0.05)。多因素Logistic回归分析结果显示,血清FAR、γ-GGT、NT-proBNP升高均为影响急性期NSTEMI患者术后MACE发生的独立危险因素(OR=3.074、2.686、3.340,P均<0.05)。ROC结果显示血清FAR、γ-GGT、NT-proBNP及其联合检测预测急性NSTEMI患者术后MACE发生的曲线下面积(AUC)分别为0.681、0.690、0.733和0.790,联合检测的AUC更高(P<0.05)。结论血清FAR、γ-GGT、NT-proBNP水平升高增加了急性NSTEMI患者PCI术后MACE的发生风险,三者联合检测对患者术后不良预后有一定预测价值。

Objective To explore and analyze the predictive value of serum fibrinogen/albumin ratio(FAR),γ-glutamyl transpeptidase(γ-GGT)and N-terminal brain natrium precursor(NT-proBNP)for prognosis of patients with acute non-ST-segment elevation myocardial infarction(NSTEMI)after percutaneous coronary intervention(PCI).Methods A retrospective analysis was performed on 93 patients with acute NSTEMI undergoing PCI who admitted to Handan Central Hospital between February 2020 and February 2023.According to presence or absence of major adverse cardiovascular events(MACE)at 30 d after surgery,they were divided into MACE group(n=21)and non-MACE group(n=72).The levels of serum FAR,γ-GGT and NT-proBNP were compared between the two groups before surgery and at 30 d after surgery.The influencing of MACE were analyzed by univariate and multivariate Logistic regression analysis.The predictive value of serum FAR,γ-GGT and NT-proBNP for MACE was analyzed by receiver operating characteristic(ROC)curves.Results In MACE group,the age was(65.37±3.46)years;there were 2 cases with Killip grading at grade I,3 cases at gradeⅡ,5 cases at gradeⅢand 11 cases at gradeⅣ;there were 5 cases with double vessel disease and 16 cases with triple vessel disease;at 30 d after surgery,the levels of serum FAR,γ-GGT and NT-proBNP were(2.87±0.55)%,(53.27±3.06)U/L and(914.35±84.35)ng/mL,respectively.In non-MACE group,the age was(58.71±2.86)years;there were 32 cases with Killip grading at gradeⅠ,27 cases at gradeⅡ,7 cases at gradeⅢand 6 cases at gradeⅣ;there were 53 cases with double vessel disease and 19 cases with triple vessel disease;at 30 d after surgery,levels of serum FAR,γ-GGT and NT-proBNP were(2.12±0.51)%,(44.33±3.35)U/L and(656.82±75.63)ng/mL,respectively.There were statistically significant differences in age,Killip grade,number of lesions,and serum FAR,γ-GGT,and NT-proBNP levels 30 days after surgery(P<0.05);there were no statistically significant differences in gender,smoking history,history of hypertension,hyperlipidemia,history of diabetes,and serum FAR,γ-GGT,and NT-proBNP levels 1 day before surgery between the two groups(P>0.05).Multivariate Logistic regression analysis showed that increased serum FAR,γ-GGT and NT-proBNP were independent risk factors of postoperative MACE(OR=3.074,2.686,3.340;P<0.05).The results of ROC curves analysis showed that area under the curve(AUC)values of serum FAR,γ-GGT,NT-proBNP and combined detection for predicting postoperative MACE were 0.681,0.690,0.733 and 0.790,respectively,the AUC of combined detection was higher(P<0.05).Conclusion The increase of serum FAR,γ-GGT and NT-proBNP increases MACE risk in acute NSTEMI after PCI,and combined detection of the three indexes has certain predictive value for prognosis of patients.